Printed by:                Learning disAbilities Resources

                                   P.O. Box 716

                                   Bryn Mawr, PA 19010

Publishing Date:     August, 1999

Introduction

The screening is designed so that it can be used without extensive training. Some information about the student will be obtained by a person administering the screening for the first time, but much more information will be obtained after the person has administered the screening to many different students. Each time the person administers the screening the similarities and differences among students will become clearer.

This manual is divided into two parts 1) the quick start and 2) the in-depth explanation. The Quick Start section is for those who, like myself, prefer to try something and read about it later. The in-depth explanation is for those who like to read about something before trying it.

Ideally the Screening is administered individually, but parts of it can be administered to a group. However, the amount of information gained from a group administration will be less than when completed individually.

Individuals who have observed the administration of the Screening report that it flows more like a conversation than an assessment. This is because the administrator can add more questions to obtain clarification or more information about the topic being asked. Many times individuals being screened report that it did not feel like they were being tested.

The Screening usually takes about 45 to 50 minutes to administer, but, for individuals with very low self-awareness or very low basic skills, the screening may only take 15 or 20 minutes. However, the screening can take longer than an hour with individuals who need to explain everything.

1) Read through the screening and answer the questions for yourself. Record the total yes responses on the Screening Summary and note whether any of the sections correspond to your own weaknesses.

 2) Administer the screening to a family member, friend or colleague to get a feeling for how it flows. It should be administered like a conversation. Some questions do not have a yes or no answer Are you organized or disorganized? Mark yes if the person is disorganized. Score the summary sheet, and think about how the results compare to what you know about the person.

 3) Administer the screening to another person who you would not suspect of having any learning problems and compare the results to the results of the other person you screened.

 4) Administer the screening to a student who you suspect has weak academic skills and compare the results to the other two that you administered.

Page 1, Part 1

For most people being screened the personal information provides only the factual information, however, occasionally individuals will manifest problems such as remembering their age, birth date, address, or phone number. Make notes about such problems.

  Cooper Screening For Information Processing

Evaluation Date ___/___/___ Client’s Date of Birth ___/___/___ Age _____

Client’s Name _________________________________ Interviewer _________________________

Address ______________________________________ Agency ____________________________

______________________________________ S ___ M ___ D ___ W ___

City ______________________________________ State ________ Zip ____________

Phone _________________________________ ______________________________________

Reason for the Screening ____________________________________________________________

Referred by _________________________________ at __________________________________

Page 1, Part 2

The Educational History Section is designed to provide an understanding of how much and what type of educational experiences the person has had. The amount of education the person has had will set the tone for the rest of the screening. For example if the person being screened was referred by a literacy council to determine how to best teach the person to read and the person dropped out of school during the 9th grade from special education classes, the questions may need to be re-worded to simpler language. The reading section would begin with line one, and the Level II vocabulary would be used and if the person has little trouble with that level, then Level III would also be used. In contrast, if the person is a college graduate, self-referred to determine why he or she is having difficulty on the job, the questions can be asked as written, the reading section may be spot checked, Level III vocabulary would be administered and much attention would be paid to work history, social skills and any thought process which was significant.

If the person attended many schools, it is not necessary to list them all. What is important is the type of schools the person attended, e.g. public or private, regular classes or special education. If the person dropped out of school, ask why and note the reason if the person provides it. Ask if the person remembers any labels, even informal ones, that were used to describe the person’s school performance such as: dyslexic, learning disabled, slow learner, not living up to potential, good with their hands etc. Any other information about the person’s educational history can be noted on page 12 (Observations, Notes).

Current grade or last grade completed __________

Schools ____________________________________________

____________________________________________ Best Subject ____________

____________________________________________ Worst Subject __________

Did you drop out of high school before graduation? Yes ____

Did you like school? (Mark yes if the person disliked school.) Yes ____

Did you ever fail a subject or repeat a grade? Yes ____

Did you ever have to attend summer school to make up work? Yes ____

Did you have difficulty with English or Language Arts classes? Yes ____

Did you have difficulty with math classes? Yes ____

Were you ever in special education classes? Yes ____

Were you ever tested for a learning disability, ADD or other problems? Yes ____

If yes, at what age? ____________

Were you ever labeled? (e.g. LD, ADD, dyslexic, brain damaged Yes ____

emotionally disturbed, retarded, a behavioral problem, slow learner, etc.)

What Label (s) ___________________________________________________________

Reported Problems ________________________________________________________

Page 2, Part 1

Were you an active child? Yes ____

Were you ever called hyper or hyperactive, even informally? Yes ____

Are you an active person now? Yes ____

Do you have a high energy level compared to your peers? Yes ____

Do you find your mind racing so you get too many ideas or thoughts at once? Yes ____

Do you have many tasks, projects, going on at once? Yes ____

Do you have a short attention span? Yes ____

Do you have a tendency to day dream? Yes ____

Do you leave doors and drawers open? Yes ____

Are you easily distracted? Yes ____

Summary of Attention Problems Yes Total # ___

Motor Skills

Page 2, Part 2

 What to look for?

Do you have poor handwriting? Yes ____

Did you avoid playing sports as a child? Yes ____

Do you avoid playing sports now? Yes ____

Do you find driving difficult? Yes ____

Are you a poor driver? Yes ____

Do you frequently drop or spill things? Yes ____

Do you consider yourself clumsy? Yes ____

Do you have problems with hand/eye coordination? Yes ____

Page 2, Part 3 

 What to look for?

Do you find yourself listening to more than one conversation at a time? Yes ____

Rhyme the word:

CAT _______________ _______________ __________________

SLOW _______________ _______________ __________________

QUICK _______________ _______________ __________________

Person has difficulty rhyming? Yes ____

Do you often mishear words that are said to you? Yes ____

Do you misinterpret what is said to you? Yes ____

Do you take things that are said too literally or miss double meaning or jokes? Yes ____

Do you have difficulty paying attention to long conversations or lectures? Yes ____

Do you have difficulty hearing what one person is saying when there are

a lot of people talking? Yes ____

Does your mind race ahead thinking about the first things that was said

to you so you do not hear or pay attention to the rest of what was said? Yes ____

Do you have difficulty with spelling? Yes ____

Do you have difficulty reading (decoding or sounding out) unfamiliar words? Yes ____

Page 3, Part 1

 Special considerations:

Do you confuse you right and left? Yes ____

Check: How do you know your right and left? ____________________________

Did you reverse letters or numbers as a child? Yes ____

Do you reverse letters or numbers now, or get phone numbers wrong? Yes ____

Do you have to stop and think when someone tells you to turn right or left? Yes ____

Do you have difficulty making choices (what to eat, where to go, what to do)? Yes ____

Do you have to stop and think which way to loosen a screw that is tight? Yes ____

Do you point one way when you mean the other or say the opposite as you point? Yes ____

Do you have difficulty with North, South, East and West? Yes ____

Do you find True and False questions difficult or do you read too much into questions? Yes ____

Do you find the same is true for some multiple choice questions, or have

difficulty deciding between two answers which are similar? Yes ____

Do you find yourself stopping for green lights? Yes ____

Do you get lost in large buildings, malls or parking lots? Yes ____

Do you have difficulty reading maps or have to turn them to match the direction you

are traveling? Yes ____

Summary of Right/Left Discrimination Yes Total # ___

Page 3, Part 2 

Are you organized or disorganized? disorganized Yes ____

Do you tend to collect too many things? Yes ____

Is your living or work space messy or disorganized? Yes ____

Do you misplace or lose things, especially little things such as keys, combs

glasses, pens, pencils, homework, tools, utensils, etc.? Yes ____

Are you often late? Yes ____

Do you have difficulty planning or using free or unstructured time? Yes ____

Do you have difficulty organizing your ideas when you write? Yes ____

Do you have difficulty organizing your ideas when your speak? Yes ____

Summary of Organizational Skills Yes Total # ___

Page 3, Part 3

 What to look for?

Are you employed or unemployed? unemployed Yes ____

Do you have difficulty learning new jobs? Yes ____

Do you have difficulty completing tasks on the job? Yes ____

Have you ever been fired because of such problems? Yes ____

Are you or have you been a client of Vocational Rehabilitation? Yes ____

What types of jobs have you had?

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Summary of Employment Yes Total # ___

Are you a moody person? Yes ____

Are you a nervous person? (more than most) Yes ____

Are you a worrier? Yes ____

Any problems with alcohol? Yes ____

Any problems with drugs? Yes ____

Do you, or have you suffered from test anxiety? Yes ____

Have you ever gone blank, or froze, on a test? Yes ____

Have you ever been on medication for psychological reasons? Yes ____

(e.g. depression, anxiety, etc.)

Have you ever been hospitalized for psychological reasons? Yes ____

Did you ever have a severe head injury? If yes, at what age? _______ Did you have problems in school before the injury? _________________ Yes ____

Summary of Emotional Yes Total # ___

Page 4, Part 2

Are you shy or outgoing? shy Yes ____

Do you have difficulty making friends? Yes ____

Would you say you have only a few friends? Yes ____

Do you have difficulty getting along with members of the opposite sex? Yes ____

Would you consider yourself a social person or a loner? loner Yes ____

Do you have any children?

If yes, how many? ________ ages? _____________

Do they or did they have any learning problems or difficulties in school? Yes ____

Do you have any siblings?

If yes, how many? Brothers ___________ Sisters ______________

Do they or did they have any learning problems or difficulties in school? Yes ____

Your father’s occupation? ______________________________

Did he have any learning problems or difficulties in school? Yes ____

Your mother’s occupation? ______________________________

Did she have any learning problems or difficulties in school? Yes ____

Summary of Social and Family Yes Total # ___

Page 4, Part 3

 What to look for?

If the person reports that he/she does not talk too much but goes on and on answering the questions in this screening, you would mark a yes for that question.

Do you believe that your speaking vocabulary is smaller than others? Yes ____

When you speak, do people have difficulty understanding what you

are trying to communicate to them? Yes ____

Are there any words which you have difficulty pronouncing or get you tongue-tied? Yes ____

Do you have a tendency to ramble, changing the topic often? Yes ____

Do you talk too much? (Check: Does the person talk too much or take too long

to answers these questions?) Yes ____

Do you interrupt others? Yes ____

Writing

Page 5, Part 1 

 What to look for?

Do you have difficulty with spelling? Yes ____

Do you write a lot or only what you have to? Only what one must Yes ____

Is expressing your thoughts and ideas in writing difficult for you? Yes ____

Do you have difficulty deciding what to write about? Yes ____

Do you have difficulty taking notes? Yes ____

Do you speak better than you write? Yes ____

Do you find that when you write some of your sentences are incomplete? Yes ____

Do you often write run-on sentences? Yes ____

Do you have difficulty with grammar or with the less-used grammar rules? Yes ____

Do you have difficulty with punctuation (e.g. commas, semicolons, etc)? Yes ____

Do you skip words when you write? Yes ____

Do you procrastinate on writing assignments? Yes ____

Summary of Writing Yes Total # ___

Is the person’s handwriting slanted up or down the page? Yes ____

Is the person’s handwriting difficult to read? Yes ____

Are the letters oversized for his/her age? Yes ____

Is the alphabet incomplete? Yes ____

Does the person mix capital and small letters? Yes ____

Are there any reversals? Yes ____

Does the person write the second digit before the 1 when writing the teen numbers? Yes ____

Does the person hold the pen or pencil in an unusual way? Yes ____

Notable observations __________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Page 6, Part 1

The Basic Math Skills Section is designed to determine how a person processes math facts and sample the skill level. Rather than a paper and pencil test, this assessment of basic math skills is oral so that the administrator can observe and question the person about how he or she arrives at the answers.

If the person responds without hesitation, mark the A __ for Automatic Recall. Otherwise ask the person how he or she arrived at the answer and mark the appropriate category: D__ Delay in Automatic Recall, LD__ Long Delay, NR__ Number Relationship, G__ Guessing, CF__ Counting on Fingers, CH__ Counting in Head.

Do you often count on your fingers or in your head? Yes ____

Does the person have difficulty with the addition facts? Yes ____

Does the person have difficulty with subtraction facts? Yes ____

Did you have difficulty learning the multiplication tables? Yes ____

Does the person have difficulty with multiplication facts? Yes ____

Summary of Basic Math Skills Yes Total # ___

Page 6, Part 2

 What to look for?

Was it difficult for you to learn long division? Yes ____

Is it still difficult for you? Yes ____

Was it difficult for you to learn fractions? Yes ____

Is it still difficult for you? Yes ____

Was it difficult for you to learn decimals? Yes ____

Is it still difficult for you? Yes ____

Was it difficult for you to learn percentages? Yes ____

Is it still difficult for you? Yes ____

Was it difficult for you to learn positive and negative numbers? Yes ____

Is it still difficult for you? Yes ____

Were word problems difficult? Yes ____

Have you taken algebra? If yes, did you have difficulty with algebra? Yes ____

Have you taken geometry? If yes, did you have difficulty with geometry? Yes ____

Have you taken other math? ____________ If yes, did you have difficulty with it? Yes ____

Summary of Math Skills Yes Total # ___

Page 6, Part 3

 What to look for?

EQUAL (Equal) _______________________________ Yes ____

AVERAGE (Add) _______________________________ Yes ____

UNIT (Subtract) _______________________________ Yes ____

VARIABLE (Multiply) _______________________________ Yes ____

COMPOUND INTEREST (Divide) _______________________________ Yes ____

Summary of Math Vocabulary Yes Total # ___

Page 7, Part 1

 What to look for?

Do you read a lot or only what you have to? Only what you have to Yes ____

Do you like to read? dislikes reading Yes ____

Are you embarrassed to read out loud? Yes ____

Do you tilt your head when you read or study? Yes ____

Have the person read from the progressive reading list starting where your think the person will begin to have difficulty.

Does the person have poor word attack skills? Yes ____

Does the person have poor phonic skills? Yes ____

Does the person leave off word endings? Yes ____

Does the person add endings to words? Yes ____

Does the person leave off or change prefixes? Yes ____

Does the person misread many words? Yes ____

Have the person read something from a book, newspaper, magazine.

Does the person add words? Yes ____

Does the person skip words? Yes ____

Does the person substitute words for similar words? Yes ____

Does the person read synonyms for some words? Yes ____

Does the person have difficulty pronouncing words? Yes ____

Does the person ignore punctuation? Yes ____

Does the person have a tracking problem? Yes ____

Does the person use a finger or a marker as a guide? Yes ____

Does the person skip lines? Yes ____

Summary of Reading Yes Total # ___

Page 7, Part 2

 What to look for?

The administrator does not have to ask the questions in this section if the individual has very low reading skills. Mark the questions as "yes" which will indicate a reading problem on the Screening Summary.

Do you have difficulty paraphrasing, or summarizing in your own words, what you read? Yes ____

Do you find yourself reading whole pages without knowing what you read? Yes ____

Are you distracted by some of the words on the page (Fireworks)? Yes ____

Do you have difficulty identifying the main idea when you read? Yes ____

Do you have difficulty finding details when you read? Yes ____

Do you have difficulty going back and finding something that you read? Yes ____

Are you easily distracted when you read? Yes ____

Do you find reading textbooks difficult? Yes ____

Do you find that there are many words you don’t know the meaning of when you read? Yes ____

Do you need to read things more than once? Yes ____

Summary of Reading Comprehension Yes Total # ___

Page 8, Part 1

 What to look for?

LAKE ___________________________________ S ___ Yes _____

SLOW ___________________________________ S ___ Yes _____

CAPTURE ___________________________________ S ___ Yes _____

SMOKE ___________________________________ S ___ Yes _____

REVERSE ___________________________________ S ___ Yes _____

BEAUTIFUL ___________________________________ S ___ Yes _____

DEVELOP ___________________________________ S ___ Yes _____

BIOLOGY ___________________________________ S ___ Yes _____ CAUTION ___________________________________ S ___ Yes _____

SECTION ___________________________________ S ___ Yes _____

PASSIVE ___________________________________ S ___ Yes _____

DEDICATE ___________________________________ S ___ Yes _____

MOTIVE ___________________________________ S ___ Yes _____

FOREIGN ___________________________________ S ___ Yes _____

ARTIFICIAL ___________________________________ S ___ Yes _____

DEVISE ___________________________________ S ___ Yes _____

PHILOSOPHY ___________________________________ S ___ Yes _____

INNOVATION ___________________________________ S ___ Yes _____

THEORY ___________________________________ S ___ Yes _____

RELUCTANT ___________________________________ S ___ Yes _____

TRANQUILIZE ___________________________________ S ___ Yes _____

DILEMMA ___________________________________ S ___ Yes _____

UNANIMOUS ___________________________________ S ___ Yes _____

EXTENSIVE ___________________________________ S ___ Yes _____

CONTEMPLATE ___________________________________ S ___ Yes _____

ANTHROPOLOGY ___________________________________ S ___ Yes _____

RENAISSANCE __________________________________ S ___ Yes _____

Is the person’s vocabulary underdeveloped? Yes ____

Is the person’s vocabulary ambiguous? Yes ____

Does the person define with another part of speech? (e.g. tranquilize - pill) Yes ____

Avoidance

Is there anything you are very fearful of in any area of your life? Yes ____

Is there anything, in any area of your life, you really dislike to do? Yes ____

Is there anything, in any area of your life, that you are unable to do? Yes ____

Are there any school (academic) subjects you are fearful of? Yes ____

Are there any school (academic) subjects you really dislike? Yes ____

Are there any school (academic) subjects that you are unable to do? Yes ____

Do you ever get angry about school work? Yes ____

If yes, about what? _______________________________

Do you or did you clown around a lot in school? Yes ____

GOALS

 What to look for?

What are your goals? Short Range _____________________________________________________

_____________________________________________________

Long Range _____________________________________________________

_____________________________________________________

What do you want from this assessment? __________________________________________________

What are your career plans? ___________________________________________________________

Do you plan to continue your education? How? _____________________________________________

Where? _____________________________________________

 What to look for?

If the person mis-reads a word, write the word the person said above the word. An example would be reading went for want or play for pay.

These notes will help the administrator understand the person’s reading problems when the screening summary is being prepared.

 What to look for ?

Illegible handwriting

Too much or too little spacing between letters or numbers

Slanting up or down

Triggers (thinking a number or letter and writing the next one)

Incomplete sentence

Misspellings

Incomplete or mis-ordered alphabet

Hesitation or orally repeating the alphabet

Extra or repeated letters in the alphabet

Writing to the edge of the page

Missing numbers

Writing the second number before the one for teen numbers

Drawing which is very sophisticated or very simple

Drawing which is oversized or runs into other things

Drawing which is unusual, has strange perspective or shape

Page 12

Talking too much or having trouble staying on the topic.

Distracted by the surroundings

Becoming hostile

Refuses to cooperate

Crying or being upset when responding to a particular question

Good art or music ability

Page 13

The purpose of this page is to obtain a profile of the person’s thoughts and basic skills.

This summary does not provide a numerical score but rather a visual profile of the number of marks in the columns. See the appendix for copies of completed screening summaries.

Name __________________________________________________ Date _________________

Educational History 3 - 4 _____ 5 - 6 _____ 7 - 9 _____

Attention 2 - 3 _____ 4 - 6 _____ 7 - 10 _____

Motor Skills 2 - 3 _____ 4 - 6 _____ 7 - 8 _____

Auditory 2 - 3 _____ 4 - 6 _____ 7 - 10 _____

Right/Left Discrimination 3 - 5 _____ 6 - 8 _____ 9 - 13 _____

Organizational Skills 1 - 2 _____ 3 - 4 _____ 5 - 8 _____

Employment 1 _____ 2 - 3 _____ 4 - 5 _____

Emotional 2 - 3 _____ 4 - 5 _____ 6 - 10 _____

Social and Family 3 - 4 _____ 5 - 6 _____ 7 - 9 _____

Oral Communication 1 - 2 _____ 3 - 4 _____ 5 - 6 _____

Writing Skills 2 - 4 _____ 5 - 7 _____ 8 - 12 _____

Handwriting 2 - 3 _____ 4 - 6 _____ 7 - 10 _____

Basic Math Skills 1 - 2 _____ 3 - 5 _____

Math Skills 1 - 2 _____ 3 - 6 _____ 7 - 14 ____

Math Vocabulary 1 _____ 2 - 3 _____ 4 - 5 _____

Reading Skills 3 - 7 _____ 8 - 12 ____ 13 - 20____

Reading Comprehension 3 - 4 _____ 5 - 6 _____ 7 - 10 _____

Vocabulary 2 - 3 _____ 5 - 6 _____ 7 - 13 ____

Avoidance 2 - 3 _____ 4 - 6 _____ 7 - 9 _____

Reading List (Number correct or with little hesitation)

100 - 126 _____ 21 - 99 _____ 1 - 20 _____

Page 14 -- Part 1

Educational/Employment Plan

Reading

Spelling

Writing

Vocabulary

Math

Organization

Study Skills

 Appendix

This is the handwriting sample of Aimee, a 22 year old female. The only problem which appears on the handwriting sample is a minor problem with spacing between letters and numbers. This is the result of her writing very quickly. Her difficulties include attention and right/left discrimination problems. These also have reduced her math skills and ability to express herself in writing.

This is the handwriting sample of Debbie, a 32 year old female. Note the incomplete sentence and alphabet. Her screening summary indicate a significant learning problem in most areas except for motor skills, thus legible handwriting but very weak basic skills except in reading.

This is the handwriting sample of Chris, a 49 year old male who has a significant reading problem. Note that there is no sentence because the administrator realized that the person’s writing skills were so low that he would not be able to write a sentence. The alphabet is incomplete. The screening summary indicated a limited education and a significant auditory problem. The errors on the numbers were probably the result of his writing the numbers quickly after being frustrated by the alphabet.

This is the handwriting sample of Doris, a 50 year old female who has a significant reading problem. She did write a sentence but her ability to express herself in writing is very limited. The alphabet was incomplete because the administrator saw the person was very frustrated. The screening summary shows a limited education, auditory problems, difficulties with oral communication and weak basic academic skills. This person has worked very little during her life because of her limited skills.